In part one,I laid out my thoughts on barriers to entry centered around how we pay for telemedicine and some policy issues that exist. In part two, I want to discuss potential solutions.

Possible solutions to expand adoption

Expand services insurers reimburseGranted, many payers (health care insurance companies) do pay for telemedicine services. But insurers decide on the level of reimbursement, so this can vary widely.

Some payers follow the standards set by Medicare, which reimburses only for certain services provided to patients in underserved areas. Those services, such as the management of chronic conditions, annual wellness exams, and behavioral counseling, must be conducted face-to-face via video in an approved site, such as a hospital, doctor's office or clinic. Few payers will reimburse fully for direct to consumer telemedicine wherever the patient resides.

Medicare and other payers also limit telemedicine’s reach into many urban environments. Additionally, the requirement that the patient be located in an approved facility (medical clinic), further limits the true possibilities of telemedicine – convenience and lower costs.

Naturally, there are concerns about possible fraud and abuse, but expansion of services covered and allowing more flexibility in where the visit can take place could incentivize patients, caregivers, and providers to be more available, have better compliance with the medical plan of care, and possibly even lead to lower costs. It is a step closer to making the easy thing to do, the right thing to do.

Pay the same for telemedicine as for in-person visits

Providers, caregivers, and patients realize that telemedicine has great promise and opportunity to make a positive impact. It has been shown that many conditions can be managed safely and effectively via virtual connectivity.

If the outcomes are the same, why isn’t the payment? While not every disease process and condition can be managed remotely, many can. It is worth the conversation to pay a similar rate as face to face care.

Thirty-four states have passed parity laws. This helps ensure payers reimburse for telemedicine visits at the same rate as they would for in-person visits. That still leaves 16 states that have not passed such laws. What better way to incentivize providers and patients to consult over video than to pay the same as you would if the visit took place in the office?

Stay tuned for part three in which I present my remaining thoughts and solutions.

Harness healthcare IT to lower costs, keep pace with change and enhance quality of care.

Donald Kosiak, MD, MBA, FACEP, CPE
Dr. Donald Kosiak serves as the Chief Medical Officer for Leidos. He is responsible for providing clinical subject matter expertise and perspective, knowledge, experience, leadership and direction to ensure collaboration and alignment to business strategy across the entire Leidos organization.
Previously he has served as the Vice President for Medical Development and Executive Medical Director for Avera Health, a 32-hospital integrated medical system based in Sioux Falls, South Dakota, USA. In that role, he served as the chief medical officer of one of the top telemedicine programs in the United States. In addition, he has served as the elected Chief of Staff of the Avera McKennan Hospital, a 545-bed tertiary medical center located in Sioux Falls, South Dakota. Dr. Kosiak continues to serve in the United States Army Reserve as an emergency physician. He is a decorated officer having served three tours of duty in support of Operation Iraqi and Enduring Freedom.
Dr. Kosiak attended medical school at the University of North Dakota. He completed his emergency medicine residency at the Mayo Clinic in Rochester, Minnesota. In 2010, he completed his Masters of Business Administration from the University of Mary in Bismarck, North Dakota. He is board-certified by the American Board of Emergency Medicine and the Certifying Commission in Medical Management.

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